Jessica Lynn Lowe and Dr. Carl Hanson, Life Science – Health Science

The purpose of this project was to address a continuing and growing health disparity, healthcare of refugees. 8.2 million legal immigrants entered the United States (US) between 1986 and 1993 (Gavagan, 1998). While these numbers have slowed slightly in the past couple of years due to recent legislation, it continues to remain high with over 1 million immigrants entering the US each year since 2005 (Segal, 2010).Prior to entry into the US, immigrants must receive an initial health assessment to determine if they can enter the country. Once in the US, refugees must receive an additional medical evaluation within 30 days of arriving. This second exam is to follow-up with any previously identified conditions, communicable diseases, or health conditions that could make resettlement difficult (Arizona 2010).

While these initial assessments are generally quite thorough, very little is often known about the health needs of resettled refugees after these health assessments have been completed. Other research, conducted through interviews with recently arrived refugees, those who work with the various refugee organizations, and health practitioners, found that cultural beliefs about healthcare and difficulties in assimilation proved to be barriers in the refugees utilizing these necessary services (Morris et al, Community Health, 2009). Through prior discussions, the Office of Refugee Services in Salt Lake City has said they have found the utilization of healthcare, including prenatal services, to be an especially challenging issue when working with African refugees.

Refugees are considered a vulnerable population, especially when it comes to adequate healthcare. This is due to multiple reasons including their socioeconomic background, as well as language and cultural barriers. Refugees often have received less education than the US-born population; this is especially true among African immigrants who have often spent most of their lives in countries that are at conflict and where priorities are based on basic survival. Language and cultural barriers also drastically affect healthcare and refugees even shy away from seeking care because of these issues. These barriers can result in misunderstandings and even misinterpretation when communicating with health professionals and figuring out instructions for taking medications for example. While some people may have an interpreter with them at health-related appointments, often these individuals are family or friends and do not have the knowledge necessary to translate health and medical terminology (Derose, 2007).

Cultural differences can cause problems with communication, such as cultures where you do not speak of difficulties, but just bare them may be more apt to not tell physicians symptoms or pains they are having (Gavagan, 1998). Another difference that can effect care is that in some cultures females are not allowed to be treated by males (Fartun Abu, personal communication, 2010).

These difficulties in obtaining effective healthcare are exasperated when a woman is pregnant, as there are many issues that can occur during the pregnancy and in many cultures, especially African, the most care a woman receives for her child is when that baby is delivered by another woman in the home (Lacey, 2004). As a result, my preliminary research has shown that these populations do not seek out proper prenatal care. In conversations with some refugee women, I found that they are interested in prenatal care, but want to know how it is beneficial, where to seek it out, and want to feel comfortable with cultural issues. They are often concerned with cultural barriers and therefore shy away from seeking care. So far, my preliminary research has shown that the main reason they do not seek out care is due to female genital mutilation. This procedure varies in severity, but can include the removal of the clitoris, labia minor and/or labia major (WHO, 2010). This is an especially common issue among refugees from Africa where prevalence of genital cutting is between 5 to 99 percent of women depending on country of origin (Kahler, 1996).

This project continued to evolve at almost every step. As this project began, it became clear that the project was much too large to complete in the allotted time. While I initially approached this project as one large project, I have come to find out that due to the various cultures throughout Africa it has almost become numerous large projects, especially since my way of approaching the women with these research questions must change slightly from group to group based on their country of origin.

This project lays the groundwork for investigating the under-utilization of prenatal care amongst African refugees in Utah and make recommendations to increase the access of those services. We are currently working with the numerous community-based organizations in the development of questions that will be administered to all female refugees 18 years of age and older who are willing to participate. Questions will be asked to determine pregnancy status – never been pregnant, currently pregnant, previously pregnant; delivery status – delivered child in US, or outside the US; the years they have been in the US; and their country of origin. All of these factors will allow for us to look at various population groups and we will be able to compare answers of perceived care (those who have not delivered in the US) and actual care (those that have delivered in the US).

I have communicated with the International Rescue Committee, which works with refugees for the first two years after they have arrived and the Utah Office of Refugee Services, which has contact with numerous community-based organizations (CBOs) encompassing eighteen groups that serve refugees from fifteen separate African countries (Joe Nahas, personal communication, 2010). The reminder of this project will be done through working in collaboration with the Utah Office of Refugee Services, the International Rescue Committee, and other various local community and faith-based organizations that currently provide outreach assistance to this specific population. This research will allow valuable recommendations to be made to various organizations that work with refugees, as well as furthering understanding among health professionals in public health and medicine, which should result in positive changes to African refugees’ experiences regarding prenatal care.

References

• Arizona State Health Department. (2010). Refugee Health: Domestic Preventive Health Screening Program. Retrieved December 28, 2010 from http://www.azdhs.gov/phs/edc/refugee/ DomPrevHSP.htm.
• Derose, Kathryn Pitkin et al. (Sept-Oct 2007). Immigrants And Health Care: Sources of Vulnerability: More opportunities for immigrants to obtain legal residency and citizenship may be the best route to expanded access to care. Health Affairs 26(5).
• Gavagan, T. & Brodyaga, L. (1998). Medical Care for Immigrants and Refugees. American Family Physician.
• Herrel, N. et al. (2004). Somali refugee women speak out about their needs for care during pregnancy and delivery. Journal of Midwifery & Women’s Health.
• Kahler, L. et al. (1996). Pregnant women at risk: An evaluation of the health status of refugee women in buffalo, New York. Health Care for Women International.
• Kang, D. et al. (1998). Medicine and Society – Cultural Aspects of Caring for Refugees. American Family Physician.
• Lacey, Marc. (2004) For Africa’s Poor, Pregnancy Is Often Life Threatening. The New York Times. Retrieved December 29, 2010 from http://www.nytimes.com/2004/12/12/ international/africa/12ethiopia.html.
• Morris, M. et al. (2009). Healthcare Barriers of Refugees Post-resettlement. Journal of Community Health. Retrieved September 22, 2010 from http://www.springerlink.com/content/ 9822129p00880156.
• Segal, Uma Anand et al. (2010). Immigration worldwide: policies, practices, and trends. New York: Oxford.
• World Health Organization (WHO). (2010). Female genital mutilation. Retrieved December 31, 2010 from http://www.int/mediacentre/factsheets/fs241/en/index.html